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Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
Acknowledgment of Disclosures and Authorization
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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I acknowledge and authorize
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I consent to the collection of my consumer health data.*
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I consent to the sharing of my consumer health data with qualified home care agencies.*
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Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
Remember, this assessment is not a substitute for professional advice.
Share a few details and we will match you to trusted home care in your area:
TAC, it is better to have an "Elder Law Attorney" draw up the Power of Attorney as there are many questions that need to be asked by the attorney before the forms are complete. Plus each State has some things that are different.
I know for my own Power of Attorney, it turned into a 17 page novel as the Attorney was covering everything. At one time I worked in a law office, and even with the knowledge I had back then, I would never draw up my own.
If you try to fill out a Power of Attorney form off the Internet, all it takes is one misplaced word or one missing word to mess up the whole intent of the POA.
Plus the Attorney will ask if the party's Will is current which is important and State laws do change.... does the party have a Medical Directive [I was glad my parent's had one]..... etc.
TAC2018, without knowing your particular circumstances, it's impossible for me to advise whether you should hire an attorney to create a health care or financial, limited or comprehensive, springing or immediate, POA or DPOA, or to create one yourself using a template, or, instead to seek guardianship and/or conservatorship. If you have or anticipate complexities due to family disharmony, then contacting an elder-law attorney is most likely advisable. That said, perfectly good and usable POAs and DPOAs can be created by reasonably careful laypersons using standard forms available on-line, or at libraries, banks, nursing homes, hospitals, etc. When I did an on-line search for "(xxxxx State) power of attorney form," the following trusted websites from the Idaho Bar Association, the Idaho Legislature, and the Colorado Bar Association were among the many results. I think these sites and others might help you decide what what type of POA authority you need and whether to use the included form, or to modify it for your specific need, or hire an attorney to write one for you (some attorney-written POAs look exactly like the ones shown on these sites). http://www.cobar.org/portals/cobar/repository/SLH/chap23.pdf https://isb.idaho.gov/wp-content/uploads/tax_pwratty2012.pdf https://legislature.idaho.gov/statutesrules/idstat/title15/t15ch12/sect15-12-301/
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
I know for my own Power of Attorney, it turned into a 17 page novel as the Attorney was covering everything. At one time I worked in a law office, and even with the knowledge I had back then, I would never draw up my own.
If you try to fill out a Power of Attorney form off the Internet, all it takes is one misplaced word or one missing word to mess up the whole intent of the POA.
Plus the Attorney will ask if the party's Will is current which is important and State laws do change.... does the party have a Medical Directive [I was glad my parent's had one]..... etc.
http://www.cobar.org/portals/cobar/repository/SLH/chap23.pdf
https://isb.idaho.gov/wp-content/uploads/tax_pwratty2012.pdf
https://legislature.idaho.gov/statutesrules/idstat/title15/t15ch12/sect15-12-301/